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General NPI Number Information
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NPI Number | 1013075621
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Entity Type | Organization
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Legal Business Name | TOTAL HEALTH - MASSAGE LLC
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Dates
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Enumeration Date | 12/05/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 16304 84TH ST
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City | HOWARD BEACH
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State | NY
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Zip | 11414-3319
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Country | US
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Telephone | 718-843-0029
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Fax |
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Provider Business Mailing Address
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Address Line | 16304 84TH ST
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City | HOWARD BEACH
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State | NY
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Zip | 11414-3319
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Country | US
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Telephone | 718-843-0029
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT
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Name | PHYLLIS SEEMAN
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Credential | LMT
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Telephone | 718-843-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 004980-1
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License Number State | NY
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